Abstract
INTRODUCTION: Digital cognitive assessments offer a promising approach to monitoring cognitive impairments, but repeated use can introduce practice effects, potentially masking changes in cognitive status. We evaluated practice effects using the Defense Automated Neurobehavioral Assessment (DANA), a digital battery designed for cognitive monitoring. METHODS: We analyzed data from 116 participants from the Boston University Alzheimer's Disease Research Center, comparing response times across two DANA sessions, around 90 days apart, while controlling for cognitive status, sex, age, and education. RESULTS: Modest practice effects were found, and cognitive impairment was associated with slower response times in several tasks. Classification models, including logistic regression and random forest classification, achieved accuracies of up to 71% in assessing cognitive status. DISCUSSION: Our study establishes a framework for evaluating practice effects in digital cognitive assessment tools. Future work should expand the sample size and diversity to enhance the generalizability of findings in broader clinical contexts. HIGHLIGHTS: We systematically evaluated practice effects using the DANA battery as a case study. Modest practice effects were observed across two testing sessions, with a median inter-session interval of 93 days. Cognitive impairment was significantly associated with slower response times in key tasks (p < 0.001). Our framework offers a systematic approach for evaluating practice effects in digital cognitive tools.